Provider Demographics
NPI:1326073180
Name:SIEGMUND, ROBERT III (DPT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:SIEGMUND
Suffix:III
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 LEAVENWORTH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-1438
Mailing Address - Country:US
Mailing Address - Phone:402-553-5332
Mailing Address - Fax:402-553-5391
Practice Address - Street 1:2275 S 132ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2501
Practice Address - Country:US
Practice Address - Phone:402-333-0539
Practice Address - Fax:402-333-0539
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2436225100000X
IA03961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025229000Medicaid
NE10025229000Medicaid
IAI19172Medicare PIN
NE099668Medicare PIN
NE280653Medicare PIN